Viral Hepatitis in Children

Hepatitis, or inflammation of the liver, can sometimes affect babies and children. Known as pediatric hepatitis, this condition may cause mild or no symptoms and go away on its own. But in some cases, it can lead to more severe illness and complications like liver damage.

Viral infections cause most cases of pediatric hepatitis. The good news is that vaccines and treatments protect many children from getting hepatitis or having serious complications. Still, if you’re pregnant and have viral hepatitis, it’s possible for your baby to acquire the infection during pregnancy or delivery.

It’s also possible for teens to get viral hepatitis from intravenous drug use. The number of children and young adults admitted to the hospital with hepatitis C linked to substance use is on the rise. Meanwhile, research shows rising rates of intravenous drug use among teens. Researchers believe these trends are related.

Healthcare providers urge people to learn about hepatitis in children (and adults) and do whatever they can to prevent its spread. This might include getting vaccines at appropriate times and teaching children how they can protect themselves from infectious diseases.

Pediatric hepatitis is rare in the U.S. However, it’s more common in nations with reduced access to clean water, food and medical supplies (like vaccines).

Types of this condition

Hepatitis can be either acute or chronic. Acute hepatitis is a short-term illness. A blood test shows evidence of an active infection that can last for weeks to several months. After that point, the virus is no longer active in a child’s blood. This is because their immune system eliminated it.

In some cases, acute hepatitis can progress to chronic hepatitis. This means a child’s immune system doesn’t eliminate the virus in the acute phase. So, the virus stays in their blood for more than six months, and often for many years. This can lead to complications down the road, like problems with liver function.

The younger a child is, the greater their risk of an acute infection becoming chronic. For example, about 90% of newborns exposed to hepatitis B at birth go on to develop chronic infection. Among children exposed by age 5, 25% to 30% develop chronic infection. That number drops to less than 5% among older children.

Symptoms of hepatitis in children

Many children have no symptoms. Possible symptoms of acute hepatitis include:

• Dark-colored pee (urine)
• Light or pale poop (stool)
• Yellow skin or eyes (jaundice)
• Itchy skin
• Feeling extremely tired
• Fever over 100.4 degrees Fahrenheit
• Pain in their belly (abdomen) or joints
• Nausea or vomiting
• Not feeling hungry

These symptoms can show up anywhere from two weeks to six months after exposure to a virus that causes hepatitis. Children who have other medical conditions like HIV or cancer may have more severe symptoms.

Chronic hepatitis may cause no symptoms for many years until complications arise.

How do kids get hepatitis?

Viral infections are the usual cause. Viruses that can cause hepatitis in children include:

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D (rare in the U.S.)
• Hepatitis E (rare in the U.S.)
• Epstein-Barr virus (EBV), which is the infectious mononucleosis virus
• Cytomegalovirus (CMV)
• Adenovirus

The most common mode of transmission of Hepatitis B and Hepatitis C is from a mother to her baby during pregnancy or childbirth. This is because the viruses spread through bodily fluids.

Intravenous drug use is another cause of hepatitis in children. The hepatitis C virus can spread through contaminated needles.

Less common causes of hepatitis (nonviral) in children include:

• Medications, like acetaminophen
• Exposure to certain toxins, like alcohol
• Other medical conditions, like autoimmune conditions, genetic and metabolic causes and fatty liver disease

Complications of pediatric hepatitis

Children who develop chronic viral hepatitis may face complications years later as an adult, including:

• Cirrhosis (scarring of the liver)
• Hepatocellular carcinoma (a type of liver cancer)
• Liver failure
• Possible but rare need for a liver transplant

In some cases, these complications lead to a shortened life expectancy.

How doctors diagnose this condition

Healthcare providers diagnose pediatric hepatitis through a blood test. They’ll draw a sample of your child’s blood and check for the presence of viruses that cause hepatitis. If a virus is present, your child may need additional testing, like further blood tests (to monitor their liver function) and an abdominal ultrasound (to check the health of their liver).

How is pediatric hepatitis treated?

Treatment depends on the cause of your child’s hepatitis, their age and overall health. Possible approaches to treatment include monitoring, supportive therapy and medications.

Monitoring

A healthcare provider keeps an eye on your child’s condition. This is appropriate in cases where medications aren’t available or there’s a good chance a child will clear the infection on their own.

For example, there currently aren’t approved medications for children under age three with hepatitis C. Your child may need routine testing, including blood tests.

Supportive therapy

This often takes place alongside monitoring. Your child’s provider will recommend measures like staying hydrated, eating nutritious foods and getting plenty of rest.

Medications

Researchers are continuing to find new, safer and more effective medications for hepatitis. These include antivirals.

Direct-acting antivirals are among the latest treatments approved for children age 3 and older with hepatitis C. Treatment lasts eight to 12 weeks. In most cases, it clears the virus from the body and therefore offers a cure. It can also help prevent future complications.

When should my child see a healthcare provider?

Your child’s provider will tell you how often your child should come in for appointments and testing. Be sure to take your child to all their scheduled appointments. Call their provider if:

• Your child has new or changing symptoms
• You have questions about your child’s diagnosis or treatment plan

What can I expect if my child has hepatitis?

Your child’s prognosis (outlook) depends on many factors, including the cause of their liver inflammation and their age. Their pediatrician is the best person to ask about what you can expect going forward. They know your child’s medical history and diagnosis. Don’t hesitate to reach out with questions or concerns.

Can pediatric hepatitis be prevented?

Yes, in some cases. Vaccines can protect babies and children against hepatitis A and hepatitis B. Talk with your pediatrician about the appropriate vaccine schedule for your child.

In general, the U.S. Centers for Disease Control and Prevention recommends babies receive these vaccinations early in life. Early vaccination is especially important for hepatitis B. That’s because babies face a higher risk of chronic infection compared to older children and adults. So, they need protection when they’re most vulnerable.

Hepatitis in pregnancy

Healthcare providers in the U.S. screen anyone who’s pregnant for hepatitis B. If you test negative and haven’t been vaccinated, you can safely receive a vaccine while pregnant. Your provider will tell you if this is a good option for you.

If you’re pregnant and have hepatitis, your healthcare provider will work with you to lower the chances of an infection in the fetus.

For example, if you have hepatitis B, they may recommend you take antiviral medications during the last trimester to lower the risk of the fetus contracting the virus. Within 12 hours of birth, they’ll give your baby an HBIG injection, as well as a hepatitis B vaccine. Your baby will then complete the vaccination series at the appropriate ages.

Healthcare providers also screen for hepatitis C during pregnancy. If you test positive, your provider will tell you how to stay as healthy as possible during your pregnancy. There currently aren’t approved treatments you can take during pregnancy, and there aren’t ways to lower the risk of spreading the virus. However, your provider will tell you when your baby needs to be tested and the kind of care they might need.

Is there a hepatitis outbreak in children?

There was an outbreak in spring 2022 that researchers are still investigating. Between April 5 and July 8, 2022, pediatricians from 35 countries reported 1,010 probable cases of pediatric hepatitis. Some cases dated back to October 1, 2021. Most were in the U.S. and Europe. Unlike many other instances of pediatric hepatitis, these had no known cause.

Healthcare professionals call the illnesses associated with this outbreak “hepatitis of unknown origin” or “acute non-Hepatitis A-E hepatitis.” The term “Hepatitis A-E” refers to the set of five viruses that cause most cases of viral hepatitis. They’re numbered A, B, C, D and E.

In this outbreak, children had hepatitis without infection from any of these viruses. This outbreak led to the deaths of 22 children around the world, including 13 in the U.S. About 7% of affected children needed a liver transplant.

The children were all under age 16, and most were very young. Researchers can’t find any clear links among all these children around the world. For example, they weren’t all taking the same medications or exposed to contaminated food or water.

Researchers have ruled out the COVID-19 vaccine as the cause since most of the children hadn’t received a vaccine yet. They’re continuing to look for anything the children might have in common, and the latest research shows one virus in particular might be a common link.

Adeno-associated virus 2 (AAV2) is a virus that can only replicate in your body if you also have a “helper virus” infection, like adenovirus. AAV2 usually causes mild, if any, symptoms. However, several studies have linked AAV2 to this outbreak. This virus was present in many of the affected children.

Researchers also think some children had an abnormal immune system response to AAV2 or other viruses that are usually harmless. They’re continuing to look into these possibilities to learn why this outbreak happened and how to prevent future cases.